Provider Demographics
NPI:1760031280
Name:ABBOTT, MICHAELA ROSE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:ROSE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MICHAELA
Other - Middle Name:ROSE
Other - Last Name:MARGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7205 W CENTER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2387
Mailing Address - Country:US
Mailing Address - Phone:531-355-6900
Mailing Address - Fax:
Practice Address - Street 1:7205 W CENTER RD STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2387
Practice Address - Country:US
Practice Address - Phone:531-355-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily